Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families.


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Discussion Board  2: End of Life Care.

Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life management

Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice.

Practice 

1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families. 

2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others. 

3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death. 

4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified. 

Education 

1. Those who practice in secondary or tertiary palliative care will have specialist education and certification. 

2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula. 

3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available. 

4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families. 

Research 

1. Increase the integration of evidence-based care across the dimensions of end-of-life care. 

2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal. 

3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life. 

4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments. 

5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices. 

Administration 

1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families. 

2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care. 

3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or an injury. 

4. Support the development and integration of palliative care services for all in- and outpatients and their families. 

 
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Nursing Care Plan

Your course project is due in the next module. Continue this project by writing a nursing care plan.

Choose three priority nursing diagnoses. The nursing care plan should include:

  • What the diagnosis is related to?
  • Evidence that supports the chosen nursing diagnoses.
  • Planned outcomes that are patient-centered.

NOTE: Please follow this Rubric. I t’s for 30 points

– Semester Project Completion

Scoring Rubric:

Criteria

Points

Describes the patient that is the subject of the project including diagnoses, medications, and history OR describes the community, its strengths and problems and the mental health issue that will be the subject of the paper.

4

Includes any substance abuse or violence issues for the patient or community

2

Discusses attempted interventions, what has been successful and what has not.

4

Describes own personal thoughts about the patient’s or community’s mental health issues.

4

Describes any cognitive concerns and possible interventions.

2

Writes a nursing care plan including three priority nursing diagnoses with r/t and AEB factors.

4

Includes outcomes in NOC language and interventions in NIC language with a plan for evaluation.

4

Identifies mental health resources that can be used with the patient or community. Includes an educational tool.

4

Supports answers using academic resources, with citations in APA format.

2

Total

30

  • Nursing interventions that are evidence-based and include rationales.
  • How will you evaluate the effectiveness of the plan? Include an evaluation tool or rubric?
 
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Provide a summary of your learning style according the VARK questionnaire.

Learning styles represent the different approaches to learning based on preferences, weaknesses, and strengths. For learners to best achieve the desired educational outcome, learning styles must be considered when creating a plan. Complete “The VARK Questionnaire,” located on the VARK website, and then complete the following:

  1. Click “OK” to receive your questionnaire scores.
  2. Once you have determined your preferred learning style, review the corresponding link to view your learning preference.
  3. Review the other learning styles: visual, aural, read/write, kinesthetic, and multimodal (listed on the VARK Questionnaire Results page).
  4. Compare your current preferred learning strategies to the identified strategies for your preferred learning style.
  5. Examine how awareness of learning styles has influenced your perceptions of teaching and learning.

In a paper (750‐1,000 words), summarize your analysis of this exercise and discuss the overall value of learning styles. Include the following:

  1. Provide a summary of your learning style according the VARK questionnaire.
  2. Describe your preferred learning strategies. Compare your current preferred learning strategies to the identified strategies for your preferred learning style.
  3. Describe how individual learning styles affect the degree to which a learner can understand or perform educational activities. Discuss the importance of an educator identifying individual learning styles and preferences when working with learners.
  4. Discuss why understanding the learning styles of individuals participating in health promotion is important to achieving the desired outcome. How do learning styles ultimately affect the possibility for a behavioral change? How would different learning styles be accommodated in health promotion?

 Cite to at least three peer‐reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria. 

Note: my learning preference is mild kinesthetic

 
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Description Develop a research question in the PICOT format—population, intervention, comparison, outcome, and time—that relates to your current work environment or to a particular nursing interest


English: English US

Description Develop a research question in the PICOT format—population, intervention, comparison, outcome, and time—that relates to your current work environment or to a particular nursing interest. Consider a specific nursing intervention or nursing policy with a specific culture or patient population as the focus. In addition to developing a PICOT question, discuss the role of theory in evidence-based health promotion practice, and address the following:

Describe the selected population in your PICOT/research question and its unique health care needs. (See template for PICOT development below.)

Select a theory, and apply it to your chosen nursing intervention or nursing policy. Why did you choose this theory?

When thinking about how to evaluate (obtain an outcome) its effectiveness, what would you measure? Would you measure lab values, interview participants, or both? Why did you select the method? 

Include at least 2 scholarly articles supporting your post.

Template Examples:

The following templates can be used to develop your PICOT question:

For an Intervention question: 

• In __________ (P), how does __________ (I) compared with __________ (C) affect __________ (O) over __________ (T period of time)? 

For an Etiology question: 

• Are __________ (P) who have __________ (I) compared with those without __________ (C) at __________ risk for __________ (O) over __________ (T period of time)? 

All sources should be cited using APA format. Grammar, spelling, punctuation, and format should be correct and professional.

Note: The question developed here will be the basis for the projects in the course; that is, the literature review in Unit 3 and the project in Unit 4. Include at least 2 references to research sources. When responding to your peers this week, please provide them with constructive feedback on their PICOT question. You may need to revise your PICOT question based on instructor/peer feedback

 
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Digital Medicines For Type 2 Diabetes


Based on the summary of research findings identified from the Evidence-Based Project—Paper on Diabetes that describes a new diagnostic tool or intervention for the treatment of diabetes in adults or children, complete the following components of this assignment:

Develop a PowerPoint presentation (a title slide, 6-12 slides, and a reference slide; no larger than 2 MB) that includes the following:

  1. A brief summary of the research conducted in the Evidence-Based Project – Paper on Diabetes.
  2. A descriptive and reflective discussion of how the new tool or intervention may be integrated into practice that is supported by sound research.

While APA format is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the St

 
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What health risks associated with obesity does Mr. C. have? Is bariatric surgery an appropriate intervention? Why or why not?


The case scenario provided will be used to answer the discussion questions that follow.

Case Scenario

Mr. C., a 32-year-old single man, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He reports that he has always been heavy, even as a small child, but he has gained about 100 pounds in the last 2–3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control with sodium restriction. He current works at a catalog telephone center.

Objective Data

  1. Height: 68 inches; Weight 134.5 kg
  2. BP: 172/96, HR 88, RR 26
  3. Fasting Blood Glucose: 146/mg/dL
  4. Total Cholesterol: 250mg/dL
  5. Triglycerides: 312 mg/dL
  6. HDL: 30 mg/dL

Critical Thinking Questions

What health risks associated with obesity does Mr. C. have? Is bariatric surgery an appropriate intervention? Why or why not?

Mr. C. has been diagnosed with peptic ulcer disease and the following medications have been ordered:

  1. Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime.
  2. Ranitidine (Zantac) 300 mg PO at bedtime.
  3. Sucralfate/Carafate 1 g or 10ml suspension (500mg / 5mL) 1 hour before meals and at bedtime.

The patient reports eating meals at 7 a.m., noon, and 6 p.m., and a bedtime snack at 10 p.m. Plan an administration schedule that will be most therapeutic and acceptable to the patient.

  1. Assess each of Mr. C.’s functional health patterns using the information given. (Hint: Functional health patterns include health-perception – health management, nutritional – metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception – self-concept, role-relationship, sexuality – reproductive, coping – stress tolerance.)
  2. What actual or potential problems can you identify? Describe at least five problems and provide the rationale for each.
 
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Evidence-Based Practice and the Quadruple Aim

Assignment: Evidence-Based Practice and the Quadruple Aim

Healthcare organizations continually seek to optimize healthcare performance. For years, this approach was a three-pronged one known as the Triple Aim, with efforts focused on improved population health, enhanced patient experience, and lower healthcare costs.

More recently, this approach has evolved to a Quadruple Aim by including a focus on improving the work life of healthcare providers. Each of these measures are impacted by decisions made at the organizational level, and organizations have increasingly turned to EBP to inform and justify these decisions.

To Prepare:

  • Read the articles by Sikka, Morath, & Leape (2015); Crabtree, Brennan, Davis, & Coyle (2016); and Kim et al. (2016) provided in the Resources. 
  • Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare. 
  • Consider the impact that EBP may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery.

To Complete:

Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim. 

Your analysis should address how EBP might (or might not) help reach the Quadruple Aim, including each of the four measures of: 

  • Patient experience
  • Population health
  • Costs 
  • Work life of healthcare providers

Rubrics:

Write a brief analysis of the connection between evidence-based practice and the Quadruple Aim. Your analysis should address how evidence-based practice might (or might not) help reach the Quadruple Aim, including each of the four measures of:

 ·   Patient experience
·   Population health
·   Costs
·   Work life of healthcare providers–

Levels of Achievement:  Excellent 77 (77%) – 85 (85%)    Good 68 (68%) – 76 (76%)    Fair 60 (60%) – 67 (67%)    Poor 0 (0%) – 59 (59%)   

Written Expression and Formatting—Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.–

Levels of Achievement:  Excellent 5 (5%) – 5 (5%)    Good 4 (4%) – 4 (4%)    Fair 3.5 (3.5%) – 3.5 (3.5%)    Poor 0 (0%) – 3 (3%)   

Written Expression and Formatting—English Writing Standards:
Correct grammar, mechanics, and proper punctuation.–

Levels of Achievement:  Excellent 5 (5%) – 5 (5%)    Good 4 (4%) – 4 (4%)    Fair 3.5 (3.5%) – 3.5 (3.5%)    Poor 0 (0%) – 3 (3%)   

Written Expression and Formatting—The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.–
 
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Describe the social determinants of health and explain how those factors contribute to the development of this disease


Write a paper (2,000-2,500 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease. Refer to “Communicable Disease Chain,” “Chain of Infection,” and the CDC website for assistance when completing this assignment.

Communicable Disease Selection

  1. Chickenpox
  2. Tuberculosis
  3. Influenza
  4. Mononucleosis
  5. Hepatitis B
  6. HIV
  7. Ebola
  8. Measles
  9. Polio
  10. Influenza

Epidemiology Paper Requirements

  1. Describe the chosen communicable disease, including causes, symptoms, mode of transmission, complications, treatment, and the demographic of interest (mortality, morbidity, incidence, and prevalence). Is this a reportable disease? If so, provide details about reporting time, whom to report to, etc.
  2. Describe the social determinants of health and explain how those factors contribute to the development of this disease.
  3. Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. Are there any special considerations or notifications for the community, schools, or general population?
  4. Explain the role of the community health nurse (case finding, reporting, data collection, data analysis, and follow-up) and why demographic data are necessary to the health of the community.
  5. Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organizations contribute to resolving or reducing the impact of disease.
  6. Discuss a global implication of the disease. How is this addressed in other countries or cultures? Is this disease endemic to a particular area? Provide an example.

A minimum of three peer-reviewed or professional references is required.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to Turn it in

 
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Health Promotion And The Community.

 a research article that provides data on a chosen topic related to successful clinical prevention for an assigned population (population assigned)

· Power point maximum 12 slides (excluding title and reference slide) with speaker notes and summary paper 4 pages in APA format.

·Both  APA formatted

At least 3 References within 2 years (1 must be Healthy People 2020)

 
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Clinical Discussion Online Assignment In Class

Clinical discussion online assignment in class

L.N. is a 49-year-old white woman with a history of type 2 diabetes, obesity, hypertension, and migraine headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria and polydipsia. L.N. is 5′4″ and has always been on the large side, with her weight fluctuating between 165 and 185 lb.

Initial treatment for her diabetes consisted of an oral sulfonylurea with the rapid addition of metformin. Her diabetes has been under fair control with a most recent hemoglobin A1c of 7.4%.

Hypertension was diagnosed 5 years ago when blood pressure (BP) measured in the office was noted to be consistently elevated in the range of 160/90 mmHg on three occasions. L.N. was initially treated with lisinopril, starting at 10 mg daily and increasing to 20 mg daily, yet her BP control has fluctuated.

One year ago, microalbuminuria was detected on an annual urine screen, with 1,943 mg/dl of microalbumin identified on a spot urine sample. L.N. comes into the office today for her usual follow-up visit for diabetes. Physical examination reveals an obese woman with a BP of 154/86 mmHg and a pulse of 78 bpm.

Questions

  1. What are the effects of controlling BP in people with diabetes?
  2. What is the target BP for patients with diabetes and hypertension?
  3. Which antihypertensive agents are recommended for patients with diabetes?
 
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